Magazine article Clinical Psychiatry News

Overactive CNS Processing Tied to Fibromyalgia: When Viewed Together, Neuroimaging Studies Show Strong Neurobiologic Underpinnings of Disorder

Magazine article Clinical Psychiatry News

Overactive CNS Processing Tied to Fibromyalgia: When Viewed Together, Neuroimaging Studies Show Strong Neurobiologic Underpinnings of Disorder

Article excerpt

An "overwhelming" amount of data now suggest that patients with fibromyalgia and a number of overlapping pain syndromes have augmented pain or sensory processing in the central nervous system, resulting in real differences in pain tolerance, judging from the findings of a recent review.

Genetic findings also are accumulating that suggest specific gene mutations may predispose individuals to developing fibromyalgia (FM), according to the authors.

"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," reported Dr. Daniel J. Clauw, professor of rheumatology at the University of Michigan, Ann Arbor, and director of the U-M Chronic Pain and Fatigue Research Center, and Richard E. Harris, Ph.D., a researcher at the center and the university.

The hyperactivity of pain processing mechanisms that characterizes FM and related conditions--from irritable bowel syndrome to tension headache and temporomandibular syndrome--can occur in association with psychological factors, "but psychological factors are not in any way required for an individual to develop or maintain this augmented central pain state," they wrote.

Other investigators said in an interview that they hope to see more reviews like it, particularly since many studies of FM are low budget, small and too easily dismissed unless they are viewed together.

Neuroimaging studies, for instance, "are providing a consistent picture" when viewed together of strong neurobiologic underpinnings for FM, said Dr. Nancy Klimas, professor of medicine at the University of Miami. "But if you pull them apart, you can find faults with any one study in it having limited power, or some other limitation."

"This is what [the authors] are saying--'look at the whole picture, it's impressive,'" said Dr. Klimas. "There's some real science to go behind the pain observation."

Dr. Klimas said the review reminded her of a grand-rounds lecture she heard several years ago, in which a "prominent" department chair told students and faculty that fibromyalgia "is all in patients' heads."

"He essentially said, don't let these patients talk to each other, don't let them read anything, don't let them have any support group meetings," Dr. Klimas said. "I was livid. These patients [with FM] are often treated badly by their physicians. It's bad enough leaving without any hope that something can be done, but it's worse leaving a doctor's office having been made to feel small or patronized."

Dr. Laurence Bradley, professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama, agreed that the literature is ripe for strong conclusions. "The [review authors] are correct. A lot of new findings have emerged in the last 5-8 years ... regarding gene variance that's associated with FM itself or with [related] disorders.

"And a lot of the neuroimaging work that has been done has demonstrated very convincingly that people with FM have enhanced or abnormal transmission of sensory signals through the CNS," he said. "Behavioral studies--laboratory pain studies--also show consistent displays of abnormal pain responses in individuals with FM."

In their review, Dr. Clauw and Dr. Harris described functional imaging studies done with single-photon emission computer tomography (SPECT) and functional magnetic resonance imaging (fMRI) that show differences in neural activation between patients with FM and pain-free controls. …

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